CommercialCoverageHigh impact
Lysis of Epidural Adhesions - (Effective Date - 2026-10-15) 7.01.73
Excellus BlueCross BlueShield·NY · Pain Management, Orthopedics, Neurosurgery +1 more·Bone & Joints (Orthopedic)
Effective date
Oct 15, 2026
We identified it
Jul 16, 2026
Summary
Excellus BlueCross BlueShield has classified lysis of epidural adhesions (Racz procedure) as investigational/experimental, effective October 15, 2026. Billing codes 62263, 62264, and 62280 are marked as experimental/investigational (E/I), meaning claims for these procedures will require prior authorization and face coverage denials unless medical necessity criteria are met. Practices must immediately update billing systems to flag these codes and obtain pre-authorization before performing the procedure.
Action Required
By October 15, 2026: Billing team must update billing software to flag CPT codes 62263, 62264, and 62280 as experimental/investigational (E/I) for Excellus BlueCross BlueShield plans. Implement requirement for prior authorization before any lysis of epidural adhesions procedures are performed. Update provider encounter forms and clinical documentation templates to require explicit medical necessity documentation showing: (1) failure of conservative management, (2) failure of fluoroscopically guided epidural steroid injections, and (3) imaging evidence of epidural adhesions. Notify all interventional pain management and orthopedic providers of the investigational status. Configure billing system to automatically deny or hold claims for these codes without prior authorization documentation. Training: Educate front desk and insurance verification staff to verify Excellus coverage and obtain prior auth authorization before scheduling. Failure to obtain prior authorization will result in claim denials and member balance issues.